1/13. Endoscopic diagnosis of sarcoidosis in a patient presenting with bilateral exophthalmos and pansinusitis.sarcoidosis is a chronic granulomatous disease of unknown etiology. Otolaryngologic and ophthalmologic manifestations occur in 15 to 55% of afflicted individuals, respectively. neck masses, parotid enlargement, and facial nerve palsy are the most common presenting otolaryngologic complaints, while lacrimal gland enlargement, uveitis, and upper eyelid masses often call the attention of the ophthalmologist. biopsy reveals non-caseating granulomas, while the angiotensin converting enzyme (ACE) level may be elevated. We report an unusual case of a patient who presented with severe bilateral exophthalmos as the sole initial complaint. A prior workup included a negative conjunctival biopsy. On magnetic resonance imaging (MRI) and computed tomography (CT), the patient had pansinusitis. Endoscopic ethmoidectomies with tissue analysis revealed sarcoidosis. Further evaluation revealed no evidence of systemic disease, and all symptoms resolved with a course of oral steroids. Thus, nasal endoscopy and biopsy of affected paranasal sinus mucosa may prove a useful adjunct to the diagnosis of sarcoidosis, particularly in atypical cases.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/13. Multifocal fibrosclerosis as a possible cause of panhypopituitarism with central diabetes insipidus.Multifocal fibrosclerosis denotes a combination of similar fibrous disorders occurring at different anatomical sites. We encountered a 53-year-old male patient with orbital pseudotumor, chronic paranasal sinusitis, fibrous nodules of the lungs, intracranial pachymeningitis, and panhypopituitarism with central diabetes insipidus (DI) as a possible manifestation of multifocal fibrosclerosis. It has been reported that intracranial pachymeningitis or orbital pseudotumor associated with multifocal fibrosclerosis could invade the sella turcica causing a variety of anterior and/or posterior pituitary dysfunctions. In our case, intracranial pachymeningitis apparently involved the pituitary stalk and gland. Isolated gonadotropin deficiency, in addition to central DI, preceded panhypopituitarism. Although panhypopituitarism with central DI due to multifocal fibrosclerosis is quite rare and only one case has ever been reported, this systemic fibrotic disorder can be a possible cause of panhypopituitarism with central DI.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/13. Sinonasal disease in patients with sarcoidosis.sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/13. Lacrimal gland abscess: an unusual complication of rhinosinusitis.We report the case of a 72-year-old female suffering from mild myelodysplasia who initially presented with a peri-orbital cellulitis secondary to rhinosinusitis. The pre-septal infection failed to completely resolve despite intensive antibiotic therapy and endoscopic drainage of the sinuses. Computerised tomography revealed a complicating suppuration of the lacrimal gland. Incision and drainage of the lacrimal gland abscess led to a complete resolution of the pre-septal cellulitis. suppuration of the lacrimal gland is, as far as we are aware, a previously unreported complication of rhinosinusitis. Its presence could be borne in mind when evaluating computerised tomography scans of patients presenting with orbital complications of sinusitis, particularly in the immunocompromised.- - - - - - - - - - ranking = 7keywords = gland (Clic here for more details about this article) |
5/13. Lacrimal gland abscess complicating acute sinusitis.Infections of the lacrimal gland are uncommon, with suppuration and abscess formation being exceedingly rare. Acute bacterial dacryoadenitis may develop secondary to an adjacent infection, from blood-borne spread or after trauma. We report a paediatric case of lacrimal gland abscess thought to be caused by spread of infection from the paranasal sinuses. The possible mechanisms of spread of infection to the lacrimal gland are discussed as well as the management of this unusual complication of sinusitis.- - - - - - - - - - ranking = 7keywords = gland (Clic here for more details about this article) |
6/13. Presentation of Wegener's granulomatosis in young patients.We have reviewed 50 cases of Wegener's granulomatosis, seen at the new england Medical Center Hospital between 1970 and 1984, and were impressed that 10 (20%) of these patients were under 25 years of age, with ages ranging from 13 to 23 years. Closer examination of this younger group revealed striking differences in their presenting symptoms and organ involvement when compared to the older group of patients. The presentation of these young patients was varied, with no single predominant symptom. patients presented with otalgia and otitis media or hearing loss, fulminant sinusitis, arthralgias, and even corneal ulcers. Only one patient had "typical" rhinitis and nasal congestion. This group also had a disproportionate number of patients with involvement of the oral cavity, skin, and trachea. biopsy of these sites frequently demonstrated necrotizing vasculitis. Three of our 50 patients had intracranial involvement, leading to transient hemiplegia in the first, permanent hemiplegia in the second, and a seizure disorder in the third. Two of these patients were in the younger age group. The proportion of patients with limited and generalized Wegener's granulomatosis was the same in both the younger and older age groups. All the younger patients, however, had manifestations of the disease in the head and neck, while four of the older patients had no symptoms in the upper respiratory tract. The number of young patients in our study emphasizes the fact that Wegener's granulomatosis, indeed, occurs in the younger patient and with a greater frequency than previously supposed. This study suggests that in the teenager and young adult, with an unusual constellation of symptoms of the head and neck and accompanying systemic problems, a diagnosis of Wegener's granulomatosis should be seriously considered.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
7/13. acquired immunodeficiency syndrome associated with acanthamoeba infection and other opportunistic organisms.A 29-year-old Haitian man with acquired immunodeficiency syndrome presented with nasal obstruction and epistaxis. A computed tomogram of the head showed thickened nasal and paranasal sinus mucosa. A biopsy specimen of the turbinate disclosed inflammatory tissue containing amoebic trophozoites. The patient was empirically treated with rifampin and ketoconazole. He died four months after biopsy of other complications of acquired immunodeficiency syndrome. At autopsy, the amoebic infection was found only in the paranasal sinuses, a calf nodule, and in an intradermal abscess in the left leg. Pneumocystitis carinii pneumonia, mycobacterium avium-cellulare in the liver and retroperitoneal lymph nodes, cytomegalovirus infection of the adrenal glands, and Kaposi's sarcoma in the spleen were additionally present. The organism was cultured and studied by electron microscopy, dark-field microscopy, and immunofluorescence.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/13. Lacrimal gland enlargement as one of the ocular manifestations of Wegener's granulomatosis.Wegener's granulomatosis is characterized by chronic, focal, necrotizing and granulomatous vasculitis. The localized form involves mainly the upper or lower respiratory tracts, or both. In the commoner generalized form, the kidneys are also affected. literature findings suggest that ocular manifestations are a predominating sign in about 30% of cases. Ocular findings may include conjunctivitis, keratitis and sclerouveitis, pseudotumor of the orbit or proptosis. We report on a patient who showed bilateral episcleritis, keratitis, nasolacrimal duct obstruction and enlargement of the lacrimal gland. The latter finding was confirmed by CT scan.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
9/13. aspirin-induced asthma in children.aspirin-sensitive asthma is not well documented in children. It may present as a triad of (1) allergic rhinitis, (2) nasal polyps and/or sinusitis and (3) bronchial asthma precipitated by aspirin. Four cases in children are presented. The pathophysiology probably involves the biosynthesis of prostaglandins.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
10/13. Nasal secretions in response to acetylsalicylic acid.BACKGROUND: Acetylsalicylic acid (ASA) induces rhinorrhea in a subset of patients with asthma or chronic rhinosinusitis or both and nasal polyps. The underlying mechanism of the reaction is obscure. methods: To assess the nasal response to ASA challenge, four groups of patients were challenged orally with ASA: group A (10 ASA-sensitive patients); group B (nine patients with nasal polyps and histories of tolerance to ASA); group C (nine ASA-tolerant patients with chronic allergic rhinitis); and group D (eight healthy nonatopic subjects). RESULTS: Nasal lavages obtained before and after ASA challenge were assayed for proteins (total protein, lactoferrin, lysozyme, albumin) and inflammatory mediators (histamine, prostaglandin d2, and leukotriene c4). ASA challenges induced severe rhinorrhea and congestion and significant increases in mean concentrations of all measured nasal proteins in group A. histamine and prostaglandin d2 rose, but not significantly. In the two control groups with chronic rhinitis, ASA induced increases in the concentration of proteins and histamine. leukotriene c4 concentrations were significantly elevated in nasal lavages after ASA challenge in groups A and C only. In group D no symptoms or changes in nasal proteins were observed after aspirin challenge. CONCLUSIONS: These observations suggest that production of lipoxygenase products of arachidonate may induce glandular secretions that may participate in the clinical changes associated with ASA sensitivity.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
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